STD Awareness: Prevention vs. Punishment

Before antibiotics, syphilis could kill and gonorrhea was responsible for most cases of infertility. Both diseases could spread from husband to wife to baby, potentially destroying families. So you’d think medical breakthroughs in prevention and cures would be welcomed with open arms.

The actual history, like the humans who create it, is much more complicated.


Compassion, rather than fear and guilt, should guide medical practice.


During World War I, sexually transmitted diseases were a huge problem — second only to the 1918 flu pandemic in the number of sick days they caused (7 million, if you’re counting). The Roaring Twenties saw a sexual revolution, and by World War II, the military was once more fretting about losing manpower to debilitating infections that drew men away from the front lines and into the sick bays.

The armed forces did what it could to suppress prostitution and distract soldiers with recreational activities. But the human sex drive could not be contained: The vast majority of U.S. soldiers were having sex — even an estimated half of married soldiers were not faithful to their wives during WWII. Victory depended on soldiers’ health, so during both WWI and WWII, the military provided its sexually active soldiers with “prophylaxis,” medical treatments that could reduce risk for venereal disease — or VD, as sexually transmitted diseases were called back then.

Anyone who thinks condoms are a hassle or “don’t feel good” should read medical historian Allan M. Brandt’s description of a WWI-era prophylactic station, which soldiers were instructed to visit after sexual contact: Continue reading

STD Awareness: Gonorrhea’s Latest Dubious Honor

Wanted: Scientists who can develop novel antibiotics

A few years ago, the Centers for Disease Control and Prevention (CDC) put out a “greatest hits” list of antibiotic-resistant pathogens. More recently, in late February, the World Health Organization (WHO) followed suit with a dirty-dozen list of 12 “superbugs,” which was composed mostly of potentially fatal microbes that are becoming increasingly impervious to the drugs that once easily killed them. These are the bacteria WHO believes represent the greatest microbial threat to human health, and the list was compiled in the hopes of providing direction — and motivation — to pharmaceutical researchers who are desperately needed to develop new antibiotics.


Investing in antibiotic development now will save lives later.


A quick primer on antibiotic resistance: Antibiotics kill living organisms called bacteria, but like all living organisms, bacteria can evolve. Just as giraffes evolve longer and longer necks that allow them to eat more and more leaves, so too do bacteria evolve resistance to antibiotics. For example, a resistant bacterium can evolve the ability to spit out the drug before it has a chance to kill it, or it can evolve structural changes to its cell wall that make it impossible for the drug to attach to it.

One superbug, classified as an “urgent threat” by the CDC and a “high priority” by WHO, stands out from the pack. Unlike the other bacteria in these lists, an untreated infection with this bug isn’t thought to be deadly — but it still wreaks enough havoc to merit special attention from such esteemed bodies as the CDC and WHO. That bug is Neisseria gonorrhoeae, and you have one guess what disease it causes. (If you said gonorrhea, you guessed right.) Continue reading

STD Awareness: The Surprising Sexual Transmission of Non-STDs

What is a sexually transmitted disease, or STD? If someone catches their partner’s cold during sex, is that cold an STD? According to the Office on Women’s Health, an STD is “an infection passed from one person to another person through sexual contact.” Unless the cold was passed through sexual contact, rather than mouth-to-mouth contact, it would not be considered an STD. Others say that, for an infection to be considered an STD, its sexual transmission must make it significantly more common in the population. So, a disease like the common cold would probably be just as common even if people never had sex.


MRSA, meningitis, and the virus that causes pinkeye can be transmitted sexually.


However, there are some infections, such as hepatitis C or bacterial vaginosis, whose status as official STDs is controversial. While researchers argue with one another over where to draw the line between an STD and a non-STD, let’s take a look at some bacteria and viruses that can be transmitted sexually, even though they’re not officially categorized as “STDs.”

MRSA: Methicillin-Resistant Staphylococcus aureus

MRSA bursting out of a dead blood cell. Image: Frank DeLeo, NIAID

MRSA bursting out of a dead blood cell. Image: Frank DeLeo, NIAID

You’ve probably heard of MRSA, which is pronounced “mersa” and stands for methicillin-resistant Staphylococcus aureus — a strain of bacteria that is resistant to every antibiotic in the penicillin family, as well as others. S. aureus, or “staph” for short, is the same bacteria responsible for TSS, or toxic shock syndrome, which has most infamously been associated with the use of highly absorbent tampons. But mostly, staph is a common cause of skin infections, which could be deadly in the pre-antibiotic era, but these days usually don’t raise too many eyebrows.

Unfortunately, with the emergence of MRSA, which is difficult to treat with the usual drugs, we might once again have to worry about minor skin infections blossoming into life-threatening conditions. Additionally, MRSA has found a way to hop from person to person via sexual contact, and sexually transmitted MRSA has been documented in both heterosexual and MSM (men who have sex with men) populations. Untreated, it can lead to a form of gangrene in which tissue blackens as it dies. Continue reading

STD Awareness: Fully Antibiotic-Resistant Gonorrhea Is on the Horizon

shot-in-armWe’ve been anticipating its arrival for years now, but earlier this fall, the Centers for Disease Control and Prevention (CDC) finally made an announcement: Cases of gonorrhea resistant to the last drugs we use to cure it are emerging.

Over the years, gonorrhea has evolved resistance to every drug we’ve thrown at it — sulfonamides, penicillins, tetracyclines, macrolides, fluoroquinolones, and narrow-spectrum cephalosporins. The last line of defense we have is a one-two punch of a pair of antibiotics: azithromycin and ceftriaxone. By using two drugs, we can delay the inevitable evolution of antibiotic resistance by attacking the bacteria in two vulnerable locations, rather than just one, making it more difficult for the bug to mount a defense and pass on its superior survival skills to subsequent generations.


Prevention is paramount: Stop the spread of antibiotic resistance by practicing safer sex!


Unfortunately, we could only stave off the inevitable for so long. At their conference in September, the CDC announced a cluster of gonorrhea infections that are highly resistant to azithromycin, and that fall prey only to high doses of ceftriaxone. As gonorrhea’s tolerance to ceftriaxone increases, the infection will get more and more difficult to cure.

This cluster of drug-resistant cases was identified in Honolulu in April and May of this year, with five infections showing “dramatic” resistance to azithromycin, as well as reduced vulnerability to ceftriaxone. The good news is that these cases were cured with higher-than-usual doses of antibiotics, but the bad news is that dosages can only climb so high before a drug is no longer considered to be an effective treatment. Continue reading

STD Awareness: Gonorrhea’s Ever-Growing Resistance to Antibiotics

gonococci

Gonococci, the bacteria that cause gonorrhea.

Ever since the advent of effective antibacterial therapies less than a century ago, humans with access to these drugs can easily cure gonorrhea. Most of us in the developed world have forgotten that this disease was once a leading cause of infertility in women and blindness in babies — sulfa drugs and antibiotics not only erased these infections from our bodies, they also erased memories of gonorrhea’s dangers from our collective consciousness.


There are two drugs remaining to treat gonorrhea, and resistance to them is climbing higher as the years march on.


Unfortunately, thanks to their talent for genetic gymnastics, gonococci, the bacteria that cause gonorrhea, have been evolving resistance to every drug we’ve thrown at them — to tetracycline, to penicillin, and more recently to fluoroquinolones. One class of antibiotics remains to treat gonorrhea: cephalosporins. In 2013, Centers for Disease Control and Prevention (CDC) Director Tom Frieden warned that we could find ourselves in a “post-antibiotic era” – unless we take precautions. And, just two weeks ago, the latest study from the CDC’s Gonococcal Isolate Surveillance Project sounded the alarm that the post-antibiotic era is drawing ever closer, especially when it comes to gonorrhea.

Azithromycin and ceftriaxone, the two drugs that are used in combination to deliver a one-two punch to invading gonococci, are the best antibiotics remaining in our arsenal. Azithromycin is taken by mouth, while ceftriaxone is administered by a shot, and when taken together they team up to target different weak points in gonococci’s armor. Azithromycin interferes with the bacteria’s ability to make proteins, shutting the cells down, while ceftriaxone causes the cell wall to fall apart. However, the gonococci can acquire resistance. For example, in the case of azithromycin, a resistant bacterium can spit out the drug before it has a chance to kill it, or it can change the shape of its protein-making apparatus such that the drug can’t attach to it.  Continue reading

STD Awareness: Which STDs Are Resistant to Antibiotics?

pillsYou’ve probably heard of MRSA, which is pronounced “mersa” and stands for methicillin-resistant Staphylococcus aureus — a strain of bacteria that is resistant to methicillin, as well as pretty much every other antibiotic out there. MRSA is an example of evolution by natural selection — what didn’t kill its ancestors made them stronger, spawning a drug-resistant strain.


There are drug-resistant strains of gonorrhea, trichomoniasis, and syphilis.


Evolution is the force behind life’s diversity. Normally, diversity is a good thing — but when it comes to microbes that cause diseases like gonorrhea, trichomoniasis, and syphilis, these organisms’ ability to evolve new defenses against our antimicrobial drugs isn’t good for us.

STDs have plagued us for millennia, but it wasn’t until the 20th century that we finally developed antibiotics, which gave us a powerful tool against many of our most formidable sexually transmitted foes. Suddenly, scourges like gonorrhea and syphilis could be quickly and easily treated with a dose of penicillin.

Problem solved, right? Nope. Enter evolution by natural selection. Continue reading

STD Awareness: Will STDs Go Away on Their Own?

teensCan gonorrhea go away without treatment? Does chlamydia eventually clear up? Can trichomoniasis go away on its own? These are the kinds of questions people pose to Google before Google sends them here — at least that’s what I learned by looking at the blog’s stats. They’re tricky questions to tackle, and for so many reasons.

Some viral STDs stay with you for life, such as herpes and HIV. Others, such as hepatitis B and human papillomavirus (HPV), can be prevented with vaccines but cannot be cured. It’s also possible for the immune system to defeat hepatitis B virus and HPV — but in some cases, these viruses are able to settle in for the long haul, causing chronic infections that can endure for life and even lead to cancer.


Left untreated, syphilis can kill, and gonorrhea can cause infertility.


Non-viral STDs, like chlamydia and gonorrhea, can be cured. However, they usually don’t have symptoms, or symptoms can come and go, making it seem like an infection went away when it actually didn’t. You can’t know your STD status without getting tested, and you can’t self-diagnose an STD based on symptoms and then assume the infection went away when symptoms subside. Getting tested can uncover a problem and clear the way for treatment.

Nonetheless, people want to know if an STD can go away by itself — but there aren’t many studies on the “natural history” of curable STDs like gonorrhea, chlamydia, and trichomoniasis. Studying the natural course of a curable infection would require that scientists put their subjects at risk of the dangers of long-term infection, and no ethics board would approve such an experiment. Continue reading